Two Main Types of Hypertension

John A. Macoviak MD MBA received his MD Magna Cum Laude from Georgetown University School of Medicine. Since then, the heart transplant surgeon performed a variety of ground-breaking surgeries and authored dozens of peer-reviewed articles. Now retired, John Macoviak spends his time writing and blogging about medical topics he is interested in, such as the prevention and management of hypertension and diabetes the most common costly conditions on the planet..

Hypertension, or high blood pressure, results from the blood pushing against the arteries with more pressure than normal. Most people who are hypertensive have blood pressure readings where either the diastolic number is 90 or higher, while the systolic reading is 140 or higher. However, some providers regard readings between 130/80 and 139/89 to be hypertensive if patients have other heart risk factors present.

Primary hypertension is the most common of the two main types of hypertension. It develops over time in people as they age and does not have a specific cause. It’s believed that diet, lifestyle, age, and genetics play a role in the development of primary hypertension. The condition has been linked to lifestyle factors, like having too much alcohol and stress. Altering lifestyle can prevent the development of primary hypertension and minimize the risk of hypertension-related complications.

Roughly 5 to 10 percent of hypertension cases are secondary hypertension cases. Secondary hypertension is more prevalent in younger people and is potentially reversible if the cause of the hypertension is identified and controlled. With this type of hypertension, there is an underlying cause of the condition, including hormone abnormalities, adrenal gland disease, or narrowing of the arteries going from the heart to the kidneys. 

Can TSH Test Support Mild Hyperthyroidism Diagnosis?

John Macoviak MD MBA a retired heart transplant surgeon, is the co-author of a number of scientific papers on heart conditions and their treatment. John Macoviak dedicated his years of work in the clinic to providing information on innovative ways to improve diagnosis and treatment of heart conditions - as well as heart problem-causing diseases. His research on severe nonthyroidal illness diagnosis led to the publication “Diagnostic performance of sensitive measurements of serum thyrotropin during severe nonthyroidal illness: their role in the diagnosis of hyperthyroidism.”

A condition of the thyroid (a small butterfly-shaped gland at the front of the neck), hyperthyroidism occurs when the thyroid produces excessive thyroid hormones, namely T4 and T3. High amounts of these hormones speed up the metabolic rate, causing what is called a “hypermetabolic state.” When the body is in the hypermetabolic state, the heart may present with an abnormally elevated rate, which may be accompanied by elevated blood pressure.

John Macoviak MD MBA , in a clinical study with other researchers using sheep as a model, took measurements of a hormone called serum thyrotropin TSH in 21 coronary artery bypass surgery patients with no thyroid disease diagnosis (group 1), 14 heart transplant recipients with no thyroid disease diagnosis (group 2), as well as 158 random patients hospitalized for nonthyroidal illnesses. Evaluation of the results from the first two groups showed a direct relationship between TSH and free T4 FT4, and patients with prolonged subnormal TSH level (greater than one week) also had subnormal FT4. This strongly suggests the same results in severely ill non-thyroid-condition patients. Subsets of other groups, on the other hand, showed an inverse relationship between TSH and FT3 or FT4. In addition, hyperthyroidism was confirmed in 5 of 6 patients with suppressed TSH. In conclusion, TSH measurement was suggested as a useful tool in confirming mild hyperthyroidism as an addition to other tests. 

Understanding Heart Valve Disease and Its Treatment

Based in California, John Macoviak MD MBA is a retired surgeon who is specialized in Cardiothoracic Surgery. One topic that John Macoviak addresses in an article on his blog site is heart valve disease and the surgical treatments for these complex conditions.

Valvular heart disease involves the poor functioning of one or more of the four heart valves responsible for ensuring that blood flows efficiently in the proper direction. This is related to the valve leaflets that open and close with each heartbeat fail to operate correctly, which disrupts the flow of blood.

In cases of mild heart valve disease, prescribed medications and lifestyle changes, along with consistent monitoring, may be recommended. In severe or worsening situations, heart valve surgery is usually an option that involves replacement or repair of the affected valve. Repair is a first line approach, while replacing the heart valve involves using either a valve from pig or cow, human heart tissue, or a mechanical valve.

Risk factors heart patients should be aware of when considering surgical approaches include anti-coagulation medications, bleeding, infection, irregular heartbeat, and stroke. In addition, valve dysfunction that may occur in the replacement valve. 

Basics of Coronary Bypass Surgery

Cardiothoracic surgeon John Macoviak MD MBA, worked with and did heart surgery on over 3000 patients to treat a range of conditions related to heart health. Now retired, John Macoviak MD MBA shares his insights from 4 decades of research on topics such as coronary bypass surgery and heart transplantation..

Recommended in situations in which atherosclerotic plaque severely hardens and blocks the coronary arteries, bypass surgery involves the physician often removing plaque form artery, and restoring blood flow beyond certain blockages using a mammary artery or vein from the leg.

One prerequisite for the procedure is temporarily stopping the heart with a paralytic, called cardioplegia.. This process can be performed safely because the main arteries are attached to a heart-lung machine to serve as a temporary blood and oxygen pump until the surgical grafting procedure is complete. Once the paralytic agents are reversed with blood flow to the heart from the heart lung machine, , the heart is restarted and the patient begins a recovery process in an intensive care unit.